title: The usual treatment of trigeminal autonomic cephalalgias.
abstract: Trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, and rhinorrhea (SUNCT). Conventional pharmacological therapy can be successful in the majority of trigeminal autonomic cephalalgias patients. Most cluster headache attacks respond to 100% oxygen inhalation, or 6 mg subcutaneous sumatriptan. Nasal spray of sumatriptan (20 mg) or zolmitriptan (5 mg) are recommended as second choice. The bouts can be brought under control by a short course of corticosteroids (oral prednisone: 60-100 mg/day, or intravenous methylprednisolone: 250-500 mg/day, for 5 days, followed by tapering off the dosage), or by long-term prophylaxis with verapamil (at least 240 mg/day). Alternative long-term preventive medications include lithium carbonate (800-1600 mg/day), methylergonovine (0.4-1.2 mg/day), and topiramate (100-200 mg/day). As a rule, paroxysmal hemicrania responds to preventive treatment with indomethacin (75-150 mg/day). A short course of intravenous lidocaine (1-4 mg/kg/hour) can reduce the flow of attacks during exacerbations of SUNCT. Lamotrigine (100-300 mg/day) is the preventive drug of choice for SUNCT. Gabapentin (800-2700 mg/day), topiramate (50-300 mg/day), and carbamazepine (200-1600 mg/day) may be of help.
authors.affiliation: Neurological Department, University Hospital Quirón Madrid, Madrid, Spain; Neurological Department, University Hospital Fundación Alcorcón, Alcorcón, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Pareja
authors.forename: Mónica
authors.initials: M
authors.lastname: Álvarez
mesh_terms: D000588:Amines / Q000627:therapeutic use; D000818:Animals; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D005632:Fructose / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D050798:SUNCT Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D018170:Sumatriptan / Q000627:therapeutic use; D000077236:Topiramate; D016896:Treatment Outcome; D051303:Trigeminal Autonomic Cephalalgias / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D000077236:Topiramate; D005632:Fructose; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D018170:Sumatriptan; D008012:Lidocaine
keywords: SUNA; SUNCT; cluster headache; paroxysmal hemicrania; treatment; trigeminal autonomic cephalalgia